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ONSITE WASTEWATP" TREATMENT SYSTEM PERMIT <br /> SAN JOAQWN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT "OEMAINSTREET-STIX:ICI'ONCA (209)"11-3420 <br /> NON-REFUNDABLE PERMIT CALL20 953-7697F RINSPECTIONS XP SIYEARFRR DATEISSUED <br /> JOB ADDRESSLtqclj- rY CITY/ZV I m <br /> CROSS STREET el-04&X APN OJ /- 2(,0'Ol PARCEL SIZE !G.I" 0 <br /> v <br /> OWNER NAME C PHONEi <br /> Ow RADDRESS /J �M/pJiN {- CITY/STATSMP ) u CJ J <br /> CQMfRAC'FOR ^ �' /!h IO PHONE <br /> CONTRACTOR ADDRESS1-r58/S S/hT 'lv R C /� CIT ISTATF/ZIPyj(,,' A'"A 1jJ jXY 2 <br /> LICENSE O C42 O C-36 OTHER NuNumat yv,43ssss" E%PIETnON DATE 0/0 <br /> WATERTABLEDEPIN: ft f.$OGRAPHICALINPORMATION: CaordiDatn X Y <br /> D PERC TEST M BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: ❑ NEW INSTALLATION CI REFMWADDORONr � LI ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REq-ACEMLryI' dr/fVESIRUCOON <br /> INSTALLATION WILL SERVE: O RESIDENCE O COMMERCIAL O OTHER ��i <br /> NUMBEROPLNINGUNFIS: NUMBEROFBEDROOMS: NUMBEROFEMPLOYEES: <br /> 0 SEPTICTANK TYPFIMPG CAPAC gal #OFCOMPARTM S <br /> O GREASE TRAP T&VWG CAPACRY gal #OFCOMPAATMEWS <br /> DISFANCETONEAALSF: WELL ft FOUNDATION ft PROPERTYL[NE R <br /> O Lrrr STATION SIM MEMPUMP 0 PKGTEPLANT O SAND OIL Se]PARATOR(ENCLOSED SYSTEM) -( <br /> O LEACH LINES O LEACHINGCRAMBERS #OFLMES LENGTH OF LMEs ft <br /> DISTANCE TONEAREST WELL-ft FOUNDATION R PROPERTY LME R \ <br /> O FILTER BED WIDTH ft LENGTH It DEPTH fl <br /> DISTANCE m NEAREST WELL ft FOUNDATION R PROPERTY LME R 1 <br /> O MOUNDED wIDTe ft LENGTH R DEPTH R <br /> DISTANCE M NEAREST WELL ft FOUNDATION ft PROPERTY LINE R �` <br /> O SUMPS WIDTH ft LENGTH ft DF ft 1 <br /> DlsrMN rO NE,uWT WELL ft FOUNDATION R PROMW UNE It <br /> O DISPOSAL PONDS W.. R LRNGIH R DEPTH ft C <br /> DISTANCE TO NEAREST WELL ft FOUNDATION R PROPERTY LME It <br /> O SEEPAGE PITS NUMBER WIDie ft DEmi It <br /> DISTMICE TO NEARlEw WELL ft FOUNDATION ft PROPMR LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY 4 <br /> ORDINANCE$STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MIN 26 HOLM"VANCENOTICEREQUIREDPORINSPECnONS- LEASE CA/1/(209)957-769'1 <br /> SIGNED TI'T'TLE1 �a r -r DATE O ✓-�^rT/ <br /> ( <br /> I <br /> U TY <br /> N IR N E NT <br /> H Al <br /> I DEPARTMENT USE ONLY LN <br /> AppiinlioR AttePted DRte Area Employx lDp �y Y ' <br /> FiRtl lRxptttion .6 DNe � 0 SPECIAL PERMIT-Approved by <br /> CWracter of Soil to h of 3 Ft: Pit/Somp Sob Ch..d t,:. <br /> COZY MENTS <br /> CNctic�l7 �wtLha/L!!la.�.cEY7���:�IE+� /6' 1 6n/57r Get uJE3�i`�-frs <br /> PE SCL Bored Chmml Am000t PermW <br /> Code irxFO Cu fitted Date Serving utot# InveieeIt Perodt lD# <br /> L D ©o'4ti <br /> Oyl ONSOE WASTEWATER PERMIT <br />